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Why therapists should know about aphantasia

Aphantasia is a newly coined term for the inability to visualise, or to see things with your mind’s eye. You can read about it in my previous post here, or follow the links at the bottom of this page.

Since aphantasia has been gaining some media attention, I have been pondering the implications for psychological therapies. I have recently started working in mental health, and have previous experience as a service user. An understanding of aphantasia is definitely important if you are working with people who experience this.

Why should therapists/counsellors know about aphantasia? I have a memory of sitting in a counselling room, my frustration increasing as my therapist insisted that I try to visualise a calm lake. As in previous sessions, I had said I didn’t want to do this as I knew it wasn’t helpful. He thought I should keep trying. I didn’t know at that time that some people could actually visualise, but I knew that thinking about a lake seemed a stupid way to try to relax. Relaxation visualisation is a technique which is quite often used by therapists, for example a “safe space” visualisation. This is going to be confusing, frustrating, and ultimately a waste of time if the client has aphantasia.

Visualisation techniques are used in a range of therapies. I have recently done several workshops in Acceptance and Commitment Therapy. Most of the presenters used visualisation exercises in their teaching, and to demonstrate exercises they did with clients. Examples include:

One “defusion” exercise in ACT involves visualising leaves on a stream. “Visualise yourself sitting beside a gently flowing stream with leaves floating along the surface of the water. Take each thought that enters your mind and place it on a leaf… let it float by. If your thoughts momentarily stop, continue to watch the stream. Sooner or later, your thoughts will start up again. Allow the stream to flow at its own pace…”

One presenter got us to visualise someone who had made us feel supported and uplifted. We were to imagine them looking at us, looking into their eyes and seeing them seeing us. Then we were meant to bring their face closer and turn it around and put it behind our own face, so we were seeing with their eyes.

Another presented demonstrated what it is like when our anxiety is taking too much of our attention. He held up a sheet of paper, and asked a volunteer to picture all of their worries on the piece of paper. He then held it right in front of their face.

One presenter talked about working with a veteran who was experiencing intense shame about not intervening when his co-soldiers desecrated dead bodies. The therapist had supported him to visualise himself in that scene, and looking at his own face he realised how young and scared he had been at the time.

Obviously, none of these techniques would be very effective working with a client with aphantasia.

As we did the exercises, I found myself getting distracted by trying to figure out what I was meant to do. What on earth does a thought look like? What are people placing on the leaves when they do the leaves on a stream exercise?

Recently I have also been looking into EMDR (Eye Movement Desensitization and Reprocessing). A lot of the clients I work with have PTSD, and EMDR is proven to be an effective treatment for helping people process trauma. I don’t know much about EMDR, but some of the descriptions I have read involve clients identifying “a vivid visual image related to the memory” and focusing on this image (and related emotions and sensations) while engaging in EMDR processing. To work with someone with aphantasia, a therapist would need to be able to adapt their approach so that they weren’t using visualisation. I have spoken to a psychologist who uses EMDR, and she thought it would be possible to adapt the protocols in this way. On the internet I came across an account of someone who had been a client with a therapist trying to use a visualisation based EMDR procedure. The client didn’t have knowledge about aphantasia so could not explain their experience, and the therapist became very frustrated that it wasn’t working.

Obviously there are implications for a number of therapeutic approaches, and it would be good if more counsellors and therapists had an awareness that this is part of some people’s experience. If client hasn’t heard about aphantasia, it might be difficult for them to explain why something is not working for them. Knowing about aphantasia will help therapists check whether visual techniques are helpful. I think the worst thing a therapist can do is deny that a client’s experience is “real” – which is what one therapist at the conference basically said to me. “You could learn to visualise if you tried hard enough.” If she’d been my therapist, I don’t think I’d come back!

Although Adam Zeman is keen for aphantasia to be understood in terms of a variation of human experience, rather than a disorder, it can cause some people distress. This is another reason it is useful for therapists to know about aphantasia:

One of the responders to Zeman, Tom Obeyer from Ontario, Canada, said, “It had a serious emotional impact. I began to feel isolated — unable to do something so central to the average human experience. The ability to recall memories and experiences, the smell of flowers or the sound of a loved one’s voice; before I discovered that recalling these things was humanly possible, I wasn’t even aware of what I was missing out on.”

Obeyer said that the condition has severely affected his relationships since he can’t visualize his partner unless they’re physically with each other. He also struggles with the inaccessible memories of his mother who passed away. “After the passing of my mother, I was extremely distraught in that I could not reminisce on the memories we had together. I can remember factually the things we did together, but never an image. After seven years, I hardly remember her,” he said.

I have been reflecting on my experiences as a young person. I was diagnosed with Borderline Personality Disorder. Some of the experiences associated with this include:

Frantic efforts to avoid real or imagined abandonment

Identity disturbance, such as a significant and persistent unstable self-image or sense of self

Chronic feelings of emptiness

I wonder now whether having aphantasia contributed to some of these experiences being painful. If someone abandoned me, I wouldn’t be able to conjure up a picture of them – they would be gone from my head! Likewise, when alone and experiencing emotional distress, I couldn’t conjure up the faces of loved ones as a source of comfort. I was alone with my feelings, and mental darkness.

I wonder if the fact I couldn’t visualise myself as a child, or visualise myself during past experiences, could have contributed to the sense that I didn’t have a stable sense of self.

I’m sure that it is possible to have these feelings and experiences without having aphantasia, but I wonder whether, for those of us who do, it adds another layer.